SAFIR02_Lung - Efficacy of Targeted Drugs Guided by Genomic Profiles in Metastatic NSCLC Patients

NCT ID: NCT02117167

Last Updated: 2024-01-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

999 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-04-23

Study Completion Date

2023-12-31

Brief Summary

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Open label multicentric randomized phase II trial, using high throughput genome analysis as a therapeutic decision tool, aimed at comparing a targeted treatment administered according to the identified molecular anomalies of the tumor with a standard treatment (pemetrexed in Non-squamous patients and erlotinib in squamous cells, targeted substudy 1) as well as immunotherapy with maintenance therapy in patients without actionable genomic alterations or non eligible to substudy 1 (immune substudy 2).

Detailed Description

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Screening phase:

New frozen biopsy or an archived frozen sample or ctDNA sample will be sent to the genomic platforms for DNA extraction and genomic analysis (DNA microarrays and Next generation sequencing).

Patients can be considered as pre-eligible for the targeted substudy 1 randomisation phase when both following mandatory conditions have been met : stable or responding disease has been observed after 4 cycles of chemotherapy (investigator judgment) and targetable alteration has been identified by the Molecular tumor board (MTB).

If not eligible for the substudy 1 randomisation phase, patients can be considered as pre-eligible for the immune substudy 2 randomization phase when both following mandatory conditions are met: stable or responding disease (investigator judgment) is observed after 4 cycles of a platinum-based chemotherapy AND not eligible to randomization in the substudy 1 (because patient had no targetable alteration identified by the Molecular Tumor Board, or failed to have a genomic profile for the tumor \[low tumor cells percentage, technical issue during genomic analysis, etc.\], or a non-inclusion criteria that precluded entry into the substudy 1)

Randomization phase:

The mandatory post-chemotherapy 28-day wash-out period following cycle 4 of chemotherapy will provide time to achieve all the required tests and examinations.

The randomization program will allocate the following treatments with a 2:1 ratio in favor of Arm A of the considered substudy:

Substudy 1 : targeted therapies versus standard maintenance therapy

* Arm A1 / targeted arm: targeted maintenance from a list of 6 targeted drugs guided by the genomic analysis, or
* Arm B1 / standard arm : standard maintenance (pemetrexed in non-squamous and standard practice in squamous NSCLC).

Substudy 2 : immunotherapy versus standard maintenance therapy

* Arm A2 / immunotherapy maintenance arm: MEDI4736 or
* Arm B2 / standard arm : standard maintenance (pemetrexed in non-squamous and standard practice in squamous NSCLC).

Conditions

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Non-small Cell Lung Cancer Metastatic

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Substudy 1: targeted agent

Arm A1/ targeted arm: targeted maintenance from a list of targeted drugs guided by the genomic analysis, AZD2014 tablet per os 50 mg bd, continuous dosing, AZD4547 tablet per os 80 mg bd, 2 weeks on/1 week off, AZD5363 capsule per os 480 mg bd, 4 days on/3 days off, AZD8931 tablet per os 40 mg bd, continuous dosing, selumetinib capsule per os 75 mg bd, continuous dosing, vandetanib tablet per os 300 mg od, continuous dosing, olaparib tablet per os 300 mg bd continuous dosing savolitinib tablet per os 600 mg od continuous dosing

Group Type EXPERIMENTAL

AZD2014

Intervention Type DRUG

Target: m-TOR

AZD4547

Intervention Type DRUG

Target: FGFR

AZD5363

Intervention Type DRUG

Target: AKT

AZD8931

Intervention Type DRUG

Target: HER2, EGFR

Selumetinib

Intervention Type DRUG

Target: MEK

Vandetanib

Intervention Type DRUG

Target : VEGF, EGFR

savolitinib

Intervention Type DRUG

target : MET

Olaparib

Intervention Type DRUG

target : PARP

Substudy 1: standard maintenance therapy

Arm B1/ standard arm pemetrexed Intra venous 500 mg/m², every 3 weeks, standard maintenance left to the investigator's choice

Group Type ACTIVE_COMPARATOR

Standard maintenance for squamous NSCLC

Intervention Type DRUG

Pemetrexed

Intervention Type DRUG

Standard maintenance for non squamous NSCLC

Substudy 2: Immunotherapy

Arm A2/ Immunotherapy arm: maintenance with durvalumab for patient without actionable genomic alterations or non eligible to Targeted substudy 1, durvalumab Intra-venous 10 mg/kg, Q2W

Group Type EXPERIMENTAL

Durvalumab

Intervention Type DRUG

Target: PD-L1

Substudy 2: standard maintenance therapy

Arm B2/ standard arm pemetrexed Intra venous 500 mg/m², every 3 weeks, standard maintenance left to the investigator's choice

Group Type ACTIVE_COMPARATOR

Standard maintenance for squamous NSCLC

Intervention Type DRUG

Pemetrexed

Intervention Type DRUG

Standard maintenance for non squamous NSCLC

Interventions

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AZD2014

Target: m-TOR

Intervention Type DRUG

AZD4547

Target: FGFR

Intervention Type DRUG

AZD5363

Target: AKT

Intervention Type DRUG

AZD8931

Target: HER2, EGFR

Intervention Type DRUG

Selumetinib

Target: MEK

Intervention Type DRUG

Vandetanib

Target : VEGF, EGFR

Intervention Type DRUG

Standard maintenance for squamous NSCLC

Intervention Type DRUG

Pemetrexed

Standard maintenance for non squamous NSCLC

Intervention Type DRUG

Durvalumab

Target: PD-L1

Intervention Type DRUG

savolitinib

target : MET

Intervention Type DRUG

Olaparib

target : PARP

Intervention Type DRUG

Other Intervention Names

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ARRY-142866 CAPRELSA ALIMTA LYNPARZA

Eligibility Criteria

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Inclusion Criteria

* histologically proven NSCLC
* Metastatic relapse or stage IV at diagnosis, or stage IIIb not amenable to surgery or radiotherapy
* No EGFR-activating mutation or ALK translocation
* primary tumor or metastases that can be biopsied, excluding bone.
* Age \>18 years
* WHO Performance Status 0/1
* Chemo-naïve patients eligible to a first line platinum-based chemotherapy
* No tumor progression observed with the current line of treatment
* measurable target lesion or evaluable diseases RECIST


* Patients who received 4 cycles of an induction platinum-based chemotherapy and who have a SD or a PR at randomization
* presenting at least one genomic alteration from the predefined list
* Age \> 25 years for patients planned to receive AZD4547
* 28-day washout period from chemo prior to randomization and grade ≤1 residual toxicities


* Patients who received 4 cycles of an induction platinum-based chemotherapy and who have a SD or a PR at randomization
* Patients not eligible to substudy 1
* 28-day washout period from chemo prior to randomization and grade ≤1 residual toxicities

Exclusion Criteria

* Spinal cord compression and/or symptomatic or progressive brain metastases
* Abnormal coagulation contraindicating biopsy
* Inability to swallow
* Major problem with intestinal absorption
* Any clinically important abnormalities in rhythm, conduction or morphology of resting ECG
* Any factors increasing the risk of QTc prolongation or arrhythmic events
* Experience of any of the following in the preceding 12 months: coronary artery bypass graft, angioplasty, vascular stent, myocardial infarction, past or current uncontrolled angina pectoris, congestive heart failure NYHA Grade ≥2, torsades de pointes, current uncontrolled hypertension, cardiomyopathy
* Past medical history of interstitial lung disease, drug-induced interstitial disease, radiation pneumonitis which requires steroid treatment or any evidence of clinically interstitial lung disease
* Previous or current malignancies of other histologies within the last 5 years,
* Evidence of severe or uncontrolled systemic disease (active bleeding diatheses, or active Hepatitis B, C and HIV)
* Diagnosis of diabetes mellitus type I or II
* diagnosis of acne rosacea, severe psoriasis and severe atopic eczema
* Prior exposure to anthracyclines or mitoxantrone with cumulative exposure in excess of 360 mg/m² for doxorubicin, 720 mg/m² for epirubicin, or 72 mg/m² for mitoxantrone
* History of retinal degenerative disease, eye injury or corneal surgery in the previous 3 months, past history of central serous retinopathy or retinal vein occlusion, intraocular pressure \>21 mmHg, or uncontrolled glaucoma.
* History of hemorrhagic or thrombotic stroke, TIA or other CNS bleeds
* Renal disease including glomerulonephritis, nephritic syndrome, Fanconi syndrome, renal tubular acidosis
* Patients using drugs that are known potent inhibitors or potent inducers or substrates of cytochrome P450

Randomized phase:

Substudy 1:


* Life expectancy \<3 months
* Disease progression occuring at any time during chemotherapy and before randomization or toxicity that led to the discontinuation of the platinum-based chemotherapy before 4 full cycles have been delivered
* Less than 28 days from radiotherapy, less than 2 weeks from palliative radiation
* Patients previously treated with a targeted agent in the same class as agents tested in this study
* Toxicities of grade ≥2 from any previous anti-cancer therapy
* Altered haematopoietic or organ function
* Mean resting corrected QT interval (QTc) \>480msec (or QTcF \>450 msec) obtained from 3 consecutive ECGs
* Left ventricular ejection fraction (LVEF) \<55% (MUGA scan or Echocardiogram),
* Altered ophthalmic conditions confirmed by an ophthalmology specialist for patients likely to be treated with AZD4547 orAZD8931 or Selumetinib
* Patients using non-substitutable drugs, that are known to prolong QT interval or induce Torsades de Pointes, when they are supposed to be treated with vandetanib, AZD5363 or AZD8931

Substudy 2:


* Life expectancy \<3 months
* Disease progression occuring at any time during chemotherapy and before randomization or toxicity that led to the discontinuation of the platinum-based chemotherapy before 4 full cycles have been delivered
* Any previous treatment with a PD1 or PD-L1 inhibitor, including MEDI4736
* Toxicities of grade ≥2 from any previous anti-cancer therapy
* Altered haematopoietic or organ function
* Mean resting QT interval corrected for heart rate (QTc) ≥470 ms calculated from 3 consecutive ECGs using Bazett's Correction
* Current or prior use of immunosuppressive medication within 28 days before the first dose of MEDI4736, with the exceptions of intranasal and inhaled corticosteroids or systemic corticosteroids at physiological doses, which are not to exceed 10 mg/day of prednisone, or an equivalent corticosteroid
* Active or prior documented autoimmune disease within the past 2 years NOTE: Subjects with vitiligo, Grave's disease, or psoriasis not requiring systemic treatment (within the past 2 years) are not excluded
* History of primary immunodeficiency
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Intergroupe Francophone de Cancerologie Thoracique

OTHER

Sponsor Role collaborator

Fondation ARC

OTHER

Sponsor Role collaborator

AstraZeneca

INDUSTRY

Sponsor Role collaborator

UNICANCER

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Fabrice BARLESI, Pr

Role: PRINCIPAL_INVESTIGATOR

CHU Hopital Nord Marseille

Locations

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Centre Hospitalier Henri Duffau

Avignon, , France

Site Status

Centre Hospitalier Universitaire de Besancon - Hopital Jean Minjoz

Besançon, , France

Site Status

Hôpital Avicenne

Bobigny, , France

Site Status

Institut Bergonié

Bordeaux, , France

Site Status

Hôpital Ambroise Paré

Boulogne-Billancourt, , France

Site Status

Hospices Civils de Lyon- Hôpital Louis Pradel

Bron, , France

Site Status

Centre François Baclesse

Caen, , France

Site Status

CHU Caen

Caen, , France

Site Status

Chu de Caen - Hopital Cote de Nacre

Caen, , France

Site Status

Hôpital Louis Pasteur

Chartres, , France

Site Status

centre Jean Perrin

Clermont-Ferrand, , France

Site Status

CHU Clermont Ferrand - Hôpital Gabriel Montpied

Clermont-Ferrand, , France

Site Status

Hopitaux Civils de Colmar

Colmar, , France

Site Status

Centre Hopsitalier Intercommunal de Créteil

Créteil, , France

Site Status

Centre Georges François Leclerc

Dijon, , France

Site Status

CHU Grenoble

Grenoble, , France

Site Status

Chd Vendee

La Roche-sur-Yon, , France

Site Status

CH du Mans

Le Mans, , France

Site Status

Centre Oscar Lambret

Lille, , France

Site Status

CHRU de Lille

Lille, , France

Site Status

Centre Léon Bérard

Lyon, , France

Site Status

Hôpital Nord

Marseille, , France

Site Status

Institut Paoli Calmettes

Marseille, , France

Site Status

Institut de cancérologie de l'Ouest

Nantes, , France

Site Status

Centre Antoine Lacassagne

Nice, , France

Site Status

Chr Orleans

Orléans, , France

Site Status

AH-HP Hôpital Saint Louis

Paris, , France

Site Status

AP-HP Hôpital Cochin

Paris, , France

Site Status

AP-HP Hôpital Tenon

Paris, , France

Site Status

Institut Curie

Paris, , France

Site Status

Centre Hospitalier de Pau

Pau, , France

Site Status

Centre Hospitalier Lyon Sud

Pierre-Bénite, , France

Site Status

Chru Strasbourg - Nouvel Hopital Civil

Strasbourg, , France

Site Status

CHI de Toulon - Hôpital Sainte-Musse

Toulon, , France

Site Status

CHU Toulouse -Hôpital Larrey

Toulouse, , France

Site Status

Hôpital Bretonneau

Tours, , France

Site Status

Gustave Roussy

Villejuif, , France

Site Status

Countries

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France

References

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Middleton G, Crack LR, Popat S, Swanton C, Hollingsworth SJ, Buller R, Walker I, Carr TH, Wherton D, Billingham LJ. The National Lung Matrix Trial: translating the biology of stratification in advanced non-small-cell lung cancer. Ann Oncol. 2015 Dec;26(12):2464-9. doi: 10.1093/annonc/mdv394. Epub 2015 Sep 25.

Reference Type DERIVED
PMID: 26410619 (View on PubMed)

Related Links

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http://www.unicancer.fr

Unicancer official website

http://www.ifct.fr

Intergroupe Francophone de Cancérologie Thoracique (IFCT) official website

Other Identifiers

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2013-001653-27

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

UC-0105/1305 / IFCT 1301

Identifier Type: -

Identifier Source: org_study_id

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